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How to increase peak flow

SamM86 profile image

Asthma is quite a new diagnosis for me (sept 2020). I was initially using Kehale (4 puffs morning 4 puffs evening), however couldn’t get my peak flow above 300. Asthma nurse then moved me onto fostair 100/6. I have 2 puffs morning, 2 puffs lunch and 2 puffs evening and my peak flow increased to 350 however this is still a stretch from my optimum which should be 420.

I’ve had a couple of asthma attacks in the past 3 weeks for which we had to have an ambulance. After the first attack I was put on steroids for a week but my peak flow still didn’t increase however it helped with the general asthma symptoms. My last asthma attack was 2 days ago so I’m yet to speak to my GP.

I was wondering if there are any asthma veterans out there who are living with the condition and a normal life and their optimum peak flow? I miss running and not being out of breath all the time. I’m 34 and usually very fit.

8 Replies

Hey :)

Sorry to hear that you've been struggling. Peak flow is a difficult one because so many different things can affect it and the "predicted" ones are based on quite an old data set that only take age, height, gender and ethnicity into account - but loads of other things can impact it. And naturally with an average some people will be below that for their baseline and others will be above it.

Just a couple of examples! I have severe, uncontrolled asthma but my best is 500 (vs a predicted of 470), my mum has moderate asthma and her best is 330 (vs a predicted of 410) and my grandma has really mild asthma but her best is 200 (vs a predicted of about 300).

The most important thing with peak flow is your personal best and how things compare to that. If you're new to it and still experimenting with treatments then you probably won't know your best yet but normally it would be good to make a note of the best value you can reach when you're not having any symptoms and when you've had a week where you haven't needed to use your reliever inhaler more than 3 times (as more than this suggests you're still not controlled and so could improve!). Or check your peak flow, take your blue inhaler and then check again after 5-10 minutes and see if it has gone up as this would also show that there is some room for improvement.

Hopefully some of that makes sense but this is a really helpful post from EmmaF91 all about peak flow:

SamM86 profile image
SamM86 in reply to Js706

Thank you so much for taking the time to reply to me!Your information was so helpful, I think like a lot of people who are new to asthma I’ve got hooked on my peak flow!! It’s just so shocking to see how my lung health declined almost over night especially after running 5k most days 😂

Hopefully once I speak to my GP or asthma nurse on Monday we can try a new inhaler as this one still is not helping and I’m at my max dose (with the extras intake in between as it doubles as my reliever).

Have a lovely day x

EmmaF91 profile image
EmmaF91Community Ambassador in reply to SamM86

To tack on to Js706 - I’m a severe asthmatic, predicted 460, best score is 620. I have a friend with the same predicted score as me, no resp condition at all, who’s best is 300.

Try not to get caught on your PF score, but focus on your symptoms. If you’re symptom-free when you’re scoring 350 then you should be aiming to stay at 350. If you’re not then you probably need to change inhalers.

If I may ask; did the ambo give you a nebuliser, and if so what was your PF score afterwards? And have you ever used a blue reliever inhaler (when you were on kehale)?

SamM86 profile image
SamM86 in reply to EmmaF91

I was given nebuliser twice as peak flow was 180-200. After neb. It went up to 300.

I have a blue inhaler from when I was using the kehale (brown one), however my asthma nurse told me to use the fostair as my reliever. So I’m currently using the fostair for the fill limit of 8 puffs per day.

I’m not fully aware of how all these meds work but from what I understand the fostair is a mix. Could using a blue inhaler on its own be more effective? If so perhaps I could ask her on Monday?

EmmaF91 profile image
EmmaF91Community Ambassador in reply to SamM86

Ah. Ok. So you went from 50% to 85% after nebs. I just wondered as sometimes you can get a different score after nebs which can indicate what you can achieve (tho this only usually works if everything’s fully calmed down 😅).

Fostair has a steroid and long acting bronchodilator component whereas ventolin is a short acting bronchodilator. Not everyone gets on with using a MART regime, esp if they aren’t able to control flares with it. If you’re having to use the max dose everyday since starting it it suggests that MART may not be for you so it’s worth asking about options on Monday.

“The maximum daily dose is 8 inhalations.

Patients requiring frequent use of rescue inhalations daily should be strongly recommended to seek medical advice. Their asthma should be reassessed and their maintenance therapy should be reconsidered.

If patients find the treatment ineffective medical attention must be sought. Increasing use of rescue bronchodilators indicates a worsening of the underlying condition and warrants a reassessment of the asthma therapy. Sudden and progressive deterioration in control of asthma is potentially life- threatening and the patient should undergo urgent medical assessment. Consideration should be given to the need for increased treatment with corticosteroids, either inhaled or oral therapy, or antibiotic treatment if an infection is suspected.

Patients should not be initiated on Fostair NEXThaler during an exacerbation, or if they have significantly worsening or acutely deteriorating asthma. Serious asthma-related adverse events and exacerbations may occur during treatment with Fostair NEXThaler. Patients should be asked to continue treatment but to seek medical advice if asthma symptoms remain uncontrolled or worsen after initiation on Fostair NEXThaler.”

For more info on inhalers in general:

That’s wonderful information. Thank you very much

garywake profile image
garywake in reply to SamM86

One thing I was told by my GP was not to worry so much about the top rate you can achieve, but to try and get an even rate every time. When the peak flow fluctuates erratically that is the problem. I can hit 690 as a top rate but generally even out at about 650. I am 6' 1" and 55 yrs old and use fostair and Montelukast.

SamM86 profile image
SamM86 in reply to garywake

Thank you Gary, the Gp put me on Montelukast yesterday as well as continuing with the fostair. Hopefully the extra meds will help and I won’t feel so breathless all the time 🤣

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